Practice of western or modern medicine is based on a sickness rather than wellness paradigm. In this “sick care system,” most individuals visit a doctor when they are in desperate need of medical help. One of the first criticisms of the American healthcare system as a “sick care system” came from none other than Dr Joycelyn Elders, the first African American woman appointed surgeon general by President Bill Clinton in 1993. In a recent interview she reiterated her assertion saying that, “we have the very best sick care system in the world, we just don't have a health care system.” (Kay Steiger. Five Minutes With Dr Joycelyn Elders. Campus Progress, Center for American Progress, Jan. 9, 2009; www.campusprogress.org/5mw/3538/five-minute-with-dr-jocelyn-elders. Accessed Jun. 21, 2009). Another strong critic of the American sick care system is member of US Senate Tom Harkin. He has been campaigning to bring the real transformation of the existing sick care system, and also introduced legislation in the US legislature to that effect a couple of times.
According to the Organization for Economic Co-operation and Development (OECD), on average only 3% of total health expenditure in OECD countries goes toward population-wide prevention and public health programs, while most of the spending is focused on “sick care.” Adoption of the lifestyle and culture of the Western world has resulted in 80% of chronic disease related deaths in low and middle income countries (Jacqui Wise. Research network aims to tackle chronic disease in developing world. BMJ 2009; 338:b2440). Recent years have seen enormous increase in healthcare costs and yet further decline in global health. Despite Primary Health Care (PHC) programs in place almost all of the increases are attributed to care of the sick rather than preventing the population from getting sick.
A vast proportion of resources are spent on curative services, neglecting prevention and health promotion that could cut 70% of global disease burden. Without substantially reorienting, today's struggling health systems are likely to be overwhelmed by the growing challenges of aging populations and pandemics of chronic diseases.
Since time immemorial regular exercise is regarded as an important component of disease prevention and health enhancement. Hippocrates, the father of medicine who realized the value of exercise in maintaining good health, states: “All parts of the body if used in moderation and exercised in labors to which each is accustomed, become thereby healthy and well developed, and age slowly; but if unused and left idle, they become liable to disease, defective in growth, and age quickly.” The ancient Indian Yogic practices of Asanas and Pranayamas improvise health and cure chronic diseases not only by exercising the muscles, but working out the internal organs.
The increase in recent decades of life style related diseases such as obesity, diabetes and cardiovascular diseases has resulted in global pandemic that sees no decline. In the United States, approximately 65% of adults and 16% children are overweight (body mass index (BMI) at least 25 kg/m.sup.2) or obese (BMI.gtoreq.30 kg/m.sup.2). Obesity has been linked to many types of cancer (e.g., breast, colon, and prostate cancers), type 2 diabetes, coronary and congestive heart diseases, stroke, digestive diseases, respiratory diseases, osteoarthritis, and birth defects. Values of fatness and leanness are dependent on basic personal data, such as sex, age, height, weight and the like.
A large and growing body of clinical, scientific and epidemiologic evidence supports the concept of “exercise and longevity.” (Elrick H. Exercise is Medicine. Phys Sportsmed 1996: 24: 72-78). Despite this overwhelming evidence, millions of adults and children remain sedentary. Based on a 1994 study it is estimated that 168,000 of the 480,000 coronary artery disease (CAD) deaths would not have occurred if everyone were optimally active. If 30% of the population were to engage in regular exercise, defined as 30 minutes of light to moderate exercise, preferably daily, approximately 24,000 deaths from CAD per year would be averted. (Powell K E. Population attributable risk of physical inactivity. Physical Activity and Cardiovascular Health. NIH Consensus Development Conference. Dec. 18-20, 1995. NIH, Bethesda, Md.)
According to the latest recommendations from the American Heart Association and the American College of Sports Medicine the evidence from the prospective studies on disease outcomes that are inversely related to regular physical activity include cardiovascular disease, thromboembolic stroke, hypertension, type 2 diabetes mellitus, osteoporosis, obesity, colon cancer, breast cancer, anxiety and depression. Scientific evidence continues to accumulate on more conclusive evidence on stroke, some cancers, and cognitive function.
AHA/ACSM advocates Class I(A) recommendation for moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week to promote and maintain health for all healthy adults aged 18 to 65 years. Furthermore, to persons who wish to further improve their personal fitness the AHA/ACSM report recommends that such individuals can further reduce their risk for chronic diseases and disabilities or prevent unhealthy weight gain by exceeding the minimum recommended amounts of physical activity, because of the dose-response relation between physical activity and health. (Haskell W. L. et al. Physical Activity and Public Health: Updated Recommendation for Adults From the American College of Sports Medicine and the American Heart Association Circulation 2007; 116; 1081-1093).
In the HALE (Healthy Ageing: a Longitudinal study in Europe) Project Knoops et al demonstrated that lack of adherence to the low-risk lifestyle comprising of diet, nonsmoking, physical activity was associated with a population attributable risk of 60% of all deaths, 64% of deaths from coronary heart disease, 61% from cardiovascular diseases, and 60% from cancer. (Knoops T B K, et al. Mediterranean Diet, Lifestyle Factors, and 10-Year Mortality in Elderly European Men and Women. JAMA.; 292:1433-1439 (2004)).
More studies with larger cohorts and longer follow up keep building up a strong case for modification of lifestyle factors to improve cardiovascular health. (Forman J P, Stampfer M J, Curhan G C. Diet and lifestyle risk factors associated with incident hypertension in women. JAMA 2009; 302:401-411; Djoussé L, Driver J A, Gaziano J M. Relation between modifiable lifestyle factors and lifetime risk of heart failure. JAMA 2009; 302:394-400; and Roger, V L. Lifestyle and cardiovascular health. Individual and societal choices. JAMA 2009; 302:437-439).
Children, young adults and otherwise healthy individuals that engage in regular exercise can see their risk of acquired disease decline. Those with existing health conditions may see improvement in their disease process. Physical activity has the potential to benefit all. Even among older adults, a healthy lifestyle, one that includes physical activity, healthy dietary habits, smoking cessation, and light or moderate alcohol use, is associated with a significantly lower incidence of new-onset diabetes mellitus. Harvard researchers recently showed that 80% of new cases of diabetes are attributable to these risk factors, a number that increases when obesity is included as a risk factor. Combining low-risk groups for physical activity level, dietary habits, smoking habits and alcohol use produced an 82 percent lower risk of diabetes, and four in five new cases of diabetes appeared to be attributable to not having these low-risk lifestyle factors. Adding either not being overweight or not having large waist circumference was associated with an 89 percent lower risk of diabetes. (Mozaffarian, D. et al. Lifestyle Risk Factors and New-Onset Diabetes Mellitus in Older Adults,” Archives of Internal Medicine, 2009; 169[8]:798-807).
Even cancer patients have shown better prognosis and improvement in quality of life with regular physical activity. The Health, Eating, Activity and Lifestyle (HEAL) study of 933 breast cancer patients showed that moderate-intensity physical activity reduced the risk for death by 67% in women who remained active 2 years after diagnosis. This was in both, breast cancer mortality and deaths from other causes, mostly cardiovascular disease and diabetes, (Irwin, M, et al. J Clin Oncol. 2008:24; 3958-3964).
In the prospective National Institutes of Health—AARP Diet and Health Study, a total of 450 416 participants aged 50 to 71 years identified 1057 eligible incident pancreatic cancer cases. Participants were scored on 5 modifiable lifestyle factors as unhealthy (0 points) or healthy (1 point) on the basis of current epidemiologic evidence. Participants received 1 point for each respective lifestyle factor: nonsmoking, limited alcohol use, adherence to the Mediterranean dietary pattern, body mass index (≧18 and <25), or regular physical activity. A combined score (0-5 points) was calculated by summing the scores of the 5 factors. Compared with the lowest combined score (O points), the highest score (5 points) was associated with a 58% reduction in risk of developing pancreatic cancer in all participants (relative risk, 0.42; 95% confidence interval, 0.26-0.66; Ptrend<0.001). (Jiao, L, et al. A Combined Healthy Lifestyle Score and Risk of Pancreatic Cancer in a Large Cohort Study. Arch Intern Med. 2009; 169(8):764-770).
A new report from UK predicts that regular exercise and healthy diet can prevent 26% of the cases of colorectal cancer. (Parkin D M, Olsen A H, & Sasieni P (2009). The potential for prevention of colorectal cancer in the UK Eur J Cancer Prev DOI: 10.1097/CEJ.0b013e32830c8d83). In yet another study Ornish et al reported that comprehensive lifestyle changes may modify the progression of prostate cancer. In a study of 30 men with low risk prostate cancer they demonstrated that the genetic profiles of the participants were changed within 3 months in response to intense lifestyle changes. (Ornish D et al. Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention. PNAS Jun. 17, 2008 vol. 105 no. 24, 8369-8374). Change in lifestyle may alter genetic expression warding off pathological processes. Regular physical exercise and a heart-healthy diet, 2 of the mainstays of good physical health, may also be protective against age-related cognitive decline and dementia. (www.medscape.com/viewarticle/706680?sssdmh=dm1.506978&src=nldne)
Our bodies need to be exercised. We weren't meant to be inactive. Changing lifestyle is less expensive, and without the side-effects. Living on medications is expensive and with irreversible life-threatening side effects. In 1996 the U.S. Surgeon General (U.S. Department of Health and Human Services, 1996) endorsed public health recommendations that individuals minimally strive to accumulate 30 minutes or more of moderate intensity activity (like brisk walking) on most, if not all, days of the week. However, more than a decade later physical activity levels in population are still declining. (Weiss D. R. et al. Five-year predictors of physical activity decline among adults in low-income communities: a prospective study. Int J Behav Nutr Phys Act. 2007; 4: 2).
Motivators and Barriers Associated with Physical ActivityMotivatorsBarriersFeeling better/more energyNo time/too busyPromote healthExercise will not help mePrevent heart attacksLack of confidenceLower Blood PressureFacilities not convenientLook betterToo costlyLose weightExercise not interesting/painfulPersonal accomplishmentEmbarrassed of appearanceContact with friendsPoor environmentIncrease strengthIncreased fatigueSleep betterDo not make me feel betterAdapted from Will PM, Demko TM, George DL. Prescribing exercise for Health: A Simple Framework for Primary Care. Am Fam Physician 1996; 53: 579-585.
Some of the most important constraints cited are: lack of time, inconvenient, a belief that intervention will not be successful, lack of reward or measurable benefit, inadequate reimbursement, a lack of adequate training in physical activity and counseling. (Pate R R, Pratt M, Blair S N, Haskell W L, et al. Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995; 273: 402-407).
Various approaches have been designed in prior art to combat some of these constraints by inventing various types of exercise regimen, exercise equipments, treadmills and other exercise paraphernalia. There is the issue of patient adherence, of course, with most studies suggesting that patients won't keep with a rigorous weight-loss program over the long term. Most physicians don't have training in weight-loss intervention, and “most clearly have little time for lifestyle counseling in the current medical-economic climate.” Most individuals have a hard time maintaining a dedicated workout regimen. Between work, travel, and social commitments, keeping a predictable schedule of gym visits may seem nearly impossible.
Walking is the most prevalent and preferred method of physical activity for both work and leisure purposes, thus making it a prime target for physical activity promotion interventions. Step-counting devices (referred to in general as pedometers/accelerometers) are known, which, being carried by a user, enable measurement of the number of steps made, and calculation of the distance traveled, as well as supplying of additional information, such as, for example, the average speed, or the consumption of calories.
Although the invention of the pedometer is commonly attributed to U.S. President Thomas Jefferson, drawings from the 15th century indicate that Leonardo da Vinci was the conceptual originator (Gibbs-Smith, 1978). His early design appeared to be a gear-driven device with a pendulum arm designed to move back and forth with the swinging of the legs during walking.
Pedometers have been used in Japan to assess physical activity and increase walking behaviors for over 30 years. It is reported that a pedometer came onto the commercial market in 1965 under the name of manpo-meter (manpo in Japanese means 10,000 steps). Both the slogan and the pedometer were widely accepted by the public and organized walking clubs seized the concept. (Hatano, Y. Use of the pedometer for promoting daily walking exercise, Int Council Health, Phys Ed, Rec. 29 (1993), pp. 4-8.). Hatano reported that surveys conducted at walking events in Japan indicate that >90% of respondents have been aware of the slogan for more than five years and each household reports ownership of almost 2 pedometers.
When carried along with a standard pedometer, such a collection of single-purpose devices often results in inconvenient bulk, particularly for exercising runners and walkers who prefer not to be encumbered in such a manner. Additionally, leg-worn pedometers are difficult to read while moving, such that the user who wishes to know his progress must interrupt his walk, run, or jog in order to check the pedometer reading. An attempted solution has been to combine single-use devices into one multi-purpose device so that a person need carry fewer accessories.
Wireless telephones, personal data assistants, and music players of various kinds, for example, have all become standard equipment for many people regardless of their activity of the moment. Combining a pedometer with a primarily handheld device such as a mobile phone may cut down on the number of devices carried. With the small form factor, which the MEMS (Micro Electro Mechanical System) technology has made possible, accelerometers are increasingly becoming as standard hardware components in feature rich mobile phones and PDAs. Mobile phones have long been recognized as an ideal platform for pervasive applications. They are increasingly seen as a platform of choice for urban and people-centric sensing systems. They are well suited for this domain due to their ubiquity, expanding suite of sensors and ability to interact with additional external sensors via short range radiofrequency transmission. Further, given the increasing market penetration of cellular phones and the parallel trend of sole reliance on cell phones for telephonic service, they are likely to be carried at all times. Data collection and sharing via cell phones and similar mobile devices are key enablers of the instant invention. Beyond game play and screen orientation, the most popular uses for 3-axis MEMS accelerometer motion sensors in phones include power management, shake modes for control of tracks in music phones, context awareness, pedometers, so on and so forth. Therefore majority of mobile handsets introduced in the market during 2009 integrate MEMS accelerometer chips.
A cell phone may be carried in any number of locations on a person's body, such as on the belt, on an arm band, in a jacket pocket, or in the hand while talking. Such a variety of possible locations presents extreme difficulty in calibration and activity tracking, and can result in false positives or other data anomalies. Even if the device is worn in the same place through the entirety of the day, such as on the user's belt, the user will often have to move the device to check his or her progress, thus potentially providing more false positives or resulting in further lost data.
In conclusion, the value of regular physical activity and dietary regulation is now clearly established in pathogenesis of chronic diseases. Although lifestyle change has significant prophylactic/therapeutic role in controlling chronic diseases and definite advantage over the toxic prescription drugs, it is hardly exploited in everyday practice by clinicians. This is because there is no precise method to prescribe, administer, monitor and measure the quantum of dose and its effect on human health and diseases. The instant invention fills that huge void.